A&E crisis: Nearly 1,000 deaths in Wales linked to 12-hour waits as calls grow for urgent action

New figures from the Royal College of Emergency Medicine reveal 965 deaths in 2025 were associated with long emergency department waits — an average of 18 people every week.

The total is up on the previous year, with doctors warning the scale of the crisis should send “shockwaves” through the political system.

“A matter of life and death”

Emergency medicine experts say the situation inside A&E departments has become critical.

Dr Rob Perry said many of those affected were among the most vulnerable patients — people already in need of urgent hospital care.

“Any number of avoidable deaths is a tragedy — that there were almost a thousand last year should send shockwaves,” he said.

“This is a matter of life and death.”

The report points to overcrowded hospitals, high bed occupancy and delays discharging patients as key drivers — leaving emergency departments gridlocked.t door” of emergency departments, but at the “back door” — where patients cannot be moved into wards quickly enough.

How delays are linked to deaths

The analysis suggests one death occurs for every 72 patients forced to wait 12 hours or more before being admitted.

Experts say tackling patient flow through hospitals — not just demand at the front door — is key to preventing further loss of life.

The College is now calling on all parties to commit to ending deaths associated with long waits by 2030.

Government: “Real progress” on waiting lists

The stark findings come just days after the Welsh Government published its latest NHS performance figures — highlighting improvements elsewhere in the system.

According to ministers:

  • The average waiting time for treatment has fallen to around 18 weeks
  • Waiting lists have dropped for eight months in a row
  • January saw a record monthly fall of 27,900 patients

Health Secretary Jeremy Miles said the figures showed “real, tangible progress”.

“Health boards are delivering more appointments and more operations… making sure people are seen and treated faster,” he said.

How delays are costing lives

The analysis uses a recognised measure suggesting one death occurs for every 72 patients forced to wait 12 hours or more.

That equates to hundreds of potentially avoidable deaths each year.

The College is now calling on all political parties to commit to ending deaths linked to long A&E waits by 2030, warning that failure to act will lead to more lives lost.

More operations — but pressure remains

The Welsh Government says the improvements have been driven by:

  • 187,000 extra outpatient appointments
  • A record 37,000 cataract operations
  • Additional £120 million funding

There have also been improvements in ambulance response times and hospital handovers.

But ministers acknowledge winter pressures remain high, with A&E departments recording one of their busiest periods on record.

Political pressure ramps up

The figures have prompted renewed criticism from the Welsh Conservatives.

Shadow Health Secretary Peter Fox said urgent action is needed.

“Every patient deserves timely care and no one should have to wait 12 hours or more,” he said.

“This data underlines the urgent need for strong, effective action.”

He reiterated calls to declare a health emergency to bring down waiting times and end corridor care.

Welsh Liberal Democrat Leader Jane Dodds MS put the blame firmly at an overstretched social care system.

“These figures are a national scandal. Nearly a thousand people dying after waiting over 12 hours in A&E reflects a system that is fundamentally broken and causing avoidable deaths. 

“For too long, the focus has been on the front door of hospitals, when the real crisis is at the back door. Patients cannot be discharged because social care is overstretched, beds remain blocked, and A&E departments become dangerously overcrowded.

“If we are serious about ending these avoidable deaths, the next Welsh Government must properly fund social care and take a whole-system approach to fixing patient flow and funding social care properly will be a red line in any negotiations we hold with other parties.”

Two pictures of the NHS

Together, the figures paint a complex picture of the Welsh NHS.

On one hand, waiting lists are falling and more patients are being treated.

On the other, emergency departments remain under severe pressure, with long waits continuing to be linked to hundreds of deaths each year.

With a Senedd election approaching, the challenge for politicians is clear — turning progress on paper into safer care on the frontline.

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#AE #AccidentAndEmergency #EmergencyDepartment #healthEmergency #JeremyMilesMS #NHSWaitingList #NHSWales #overcrowdedHospitals #PeterFoxMS #RoyalCollegeOfEmergencyMedicine #WelshGovernment

My New Year’s Eve – 2025

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31st December 2025. I was NOT oncall.

It was a Wednesday and it was a normal working day. Hence, at 7:45am, I left to work as usual and was there by 8am. It was the New Year’s Eve. I thought that maybe, just maybe, there would be less patients in the clinic.

The day started off smoothly. Surprisingly, there were many patients who came for their follow up followed by additional patients (the defaulters and walk-ins) but it was manageable. We went about our day, seeing each patient and when lunch time came, we went for our lunch break.

At 2pm, we went about our work, seeing patients as usual and I was taking my time with each patient. The patient load in the afternoon shift was lower compared to the morning shift and both my colleagues were done with their patient load.

Suddenly, a staff nurse barged into my room saying that there is a massive accident that just occurred nearby, 2 patients were already brought in and 2 more were on their way. They called in all available doctors (which were only the three of us) to help out.

I told my colleagues to head out and help out first while I rushed through the consultation of my final patient. After that, I rushed to the tiny Emergency Room of the clinic. My colleague who was oncall on that day was already attending to a child. I went over to the other patient, an old lady and did my primary survey and fast scan.

She was desaturating badly under room air and needed oxygen support. She had an open skull fracture, multiple abrasion and laceration wounds over her face, upper and lower limbs as well as rib fractures and on top of that, her left leg appears shortened and she has a closed fracture over her right lower limb.

I didn’t think that we should proceed with an x-ray at our clinic even if we had the facility at that time, the best would be to send them straight away to the hospital because she could deteriorate further any time. Thankfully, her GCS (Glasgow Coma Scale) was full.

I was focused on my patient, stabilising while referring her to the specialists of various specialities as well as the emergency physician that when I finally got ready to transfer her out that I noticed the child that my other colleague was attending to. The child’s right arm was crushed and the distal limb of his right arm was pale and his right lung was obvious till mid-chest.

Just how in the world is he still awake? The poor child was crying out in pain…

Judging by the state of his and my patient’s injuries, it was definitely high impact.

The story was, the whole family were travelling back from Miri to Kuching. Both the parents were sitting in front and the father was driving whilst the two children and their grandmother were sitting at the back.

The father claimed that he was not speeding but as he was about to make a u-turn at a junction, he claimed to have hit the curb and the car turned many times into the other lane before finally stopping and the grandmother and one of the child were thrown out of the car.

It sounded like a very high impact collision. Thankfully, the parents and the other child were well and unscathed.

We had to transfer both patients in two separate ambulances to the Red Zone of the Emergency Department at Hospital Bintulu as one ambulance could only transport one patient at a time.

Upon arriving, I met my colleague and friend at the Red Zone of the hospital. After we have handed over to the medical officers and specialist in the Emergency Department, we headed back together. However, upon reaching back, there was another patient who came in who was extremely tachypnoiec.

Oh, here we go again… Another Red Zone referral…

We stabilised the patient and referred her to hospital again. The clock was already showing 10pm when we left. The journey to the hospital takes about 45 minutes to an hour for each journey and the both of us have yet to have our dinner. This time, I choose to accompany her for the referral, mainly for emotional support and also in hopes of stopping by McDonald’s to get a takeout.

Yes, we did stop by McDonalds after sending the patient safely to the hospital and yes, we used the ambulance and went through drive-through.

By the time we left, it was already 11pm. The journey takes around 45 minutes to an hour and it was raining heavily. At this point, I was wondering if we would end up celebrating New Year’s in the ambulance.

Me and my friend ate in the ambulance on the way back while we joked and exchange oncall stories. Thankfully, we reached a little before midnight. The day was completely unexpected, not to mention tiring but it was nice to have spent it with a friend.

It’s still the beginning of 2026, so if I’m not too late, Happy New Year!

If you are travelling anytime soon or in the future, do drive safely, stay within speed limits especially if it is raining. Remember to get your car and tyres checked before any long distance journey and NEVER drive under the influence.

Stay safe always!

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12 Hours Shift – Counting Down My Hours Each Time At Work

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How do you waste the most time every day?

At the time of writing this article, which was back in June 2025, I was going through my 6th Rotation of my Housemanship which is in the Department of Emergency and Trauma. As a House Officer in the Emergency Department, we go by the 12-hours shift.

This meant, our shift is from:

  • AM Shift: 7am till 7pm
  • PM Shift: 10am till 10pm
  • Night Shift: 10pm till 10am

In this department, they are strict in regards to adhering to a minimum of 60 hours per week in total. Thus, in a week, our schedule is as follows;

  • A total of at least 4 daytime shifts (AM or PM Shifts)
  • One night shift
  • One off day

That is provided one has off-tagged of course.

Perhaps, it is the “last paper syndrome” that I was experiencing being in the 6th and final rotation, I would be counting down my hours each day at work. Thus, upon arrival at work, I would start my “12-hours countdown on my phone.

On slow days, I made it a point to go to toilet every hour, technically my so-called “hourly break” whereas on busy days, the toilet break is the only time I could take a break. This is followed by ensuring I have at least one meal per day during my shift.

Otherwise, the schedule in the emergency department is relatively better as compared to my previous rotations. Nevertheless, the tiredness is still there.

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A short article during my 6th and final rotation of my Housemanship period where we were required to complete a 12-hour shift every day.

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#medical #emergencydepartment #healthcare #housemanship #doctor #malaysia #blogging

http://theoreticaldoctor.com/2026/01/14/12-hours-shift-counting-down-my-hours-each-time-at-work/

12 Hours Shift – Counting Down My Hours Each Time At Work

A short article during my 6th and final rotation of my Housemanship period where we were required to complete a 12-hour shift every day.

The Theoretical Doctor

2026 – The Beginning

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First of all, Happy New Year! I hope you have had a great start to this year and if you have any New Year’s Resolutions planned, I hope that you will be able to stick throughout the year.

I did not have any New Year’s Resolutions planned as I usually did the previous years. Mainly because I have just moved to a new place, settling in with things still pending in Kuching, trying to adapt to my working environment as well as picking up on new skills.

Thus, New Year’s Resolution? It’ll come as the year progresses.

My New Year’s Eve was spent at work and mainly in the ambulance with a dear friend as well as work colleague, however, that is a separate post for another time.

As usual, since I’ve started working as a doctor in 2023, I’ve always made it a point to work on New Year’s Day, a habit which I’ve adapted from my dad ever since he has started working at the age of 18.

However, New Year’s Day is a public holiday here in Sarawak. Thus, I was allocated as the oncall medical officer on the 1st of January as well as on the 2nd of January. Per oncall shift is from 8am on that day till 8am the following day (which means, mine ended at 8am on the 3rd of January).

My first case began with a case of wound breakdown over the right wrist, which the patient chose not to seek hospital treatment followed by another case of upper gastrointestinal bleed which was sent to hospital. This was then followed by another case of possible acute appendicitis which the patient and family decided to “discharge against medical advice” because they wanted to seek treatment in their hometown considering they were travelling and happened to be in the same area.

Upon returning home, I was called back for a case of breakthrough seizure likely secondary to under-dosage of medications. The patient had three episodes of seizure that day followed by a regular 1-2 monthly episodes. Hence, referred and sent to hospital.

Finally, I can return home. Time to get some rest since I would be working the next day. Shortly after, I was called back, a patient sustained laceration wound over the medial aspect of his antecubital fossa. Mechanism of injury? Unknown and he was in an extremely drunken state.

Otherwise, he was stable. Sadly, my medical assistant at that time could not be contacted to escort the patient to hospital and the family members did not have their own transportation.

If only, he was fully awake, I would have triaged him to green zone. However, transportation issues… Thankfully, the patient’s family has an uncle who was willing to send. The only thing was he needed some time to arrive due to the heavy rain and slippery roads.

I didn’t feel good leaving the patient behind although he was stable. Thus, I stayed till 4am until his uncle came and the patient himself had woken up.

After that, I went back home and straight away gotten ready for work since it’s a working day and I am still oncall.

The following day on the 2nd of January, went by smoothly during office hours with referrals here and there but it was manageable.

In the afternoon, another patient came in for symptomatic anaemia secondary to abnormal uterine bleeding with newly diagnosed cervical carcinoma. Her haemoglobin level was 5, who again, refused hospital referral claiming she visited the clinic for fever and not for her anaemic symptoms. After much convincing and discussion with my specialist, the patient still opted to “discharge against medical advice”.

Which makes me wonder… Why in the world?…

This was followed by dinner with my friend. I remembered thinking to myself that evening that maybe… just maybe… I would have a cold night. Enough of referrals.

However, at 11:30pm on the 2nd of January 2026, I received a call from my medical assistant that a patient presented to the clinic breathless with an SpO2 of 50% under room air, started on high flow mask and at best, it is only 90%.

Sounds like an impending intubation and CPR case.

I called up my friend immediately as I rushed to the car as she lives closer to the clinic. I needed all the help I could get for this patient. The roads were slippery and it was a rainy night. Yet, I sped. Thankfully, my friend had already arrived before me.

The patient?

I remembered seeing this patient on the 23rd of December 2025. At that time, his lungs already had crepitations with reduced air entry over the right side and yet he chose to “discharge against medical advice”. I remembered telling him that he would collapse if he didn’t go and true enough, here he was… sitting up, gasping for air.

His vitals? Blood pressure was sky high, lungs filled with crepitations but no pedal oedema, lines were set, no ECG done but we didn’t have time to waste…

I called up the Emergency Physician in the nearest hospital (which is an hour away), presented shortly and informed that we had to proceed with intubation because he was too tachypnoeic.

We prepared for intubation, informed the family members as well as explained the risk of CPR and death. The family understood and agreed.

Intubation… This was a difficult intubation for the guy was a very large guy with hardly any neck visible.

But before we could start, his GCS dropped and so did his heart rate, I started CPR while my friend attempted to crash intubate. We attempted to crash intubate and both times, it failed… I called up the Emergency Physician again and told her that we were 30 minutes into the CPR, she told me to call off after the current cycle.

My first death at a new workplace and on the third day of the year at 0027H, 3rd of January 2026.

Then, I proceeded to complete my notes for the family members to bring to the police station to lodge a police report and broke the news to the family. I was calm and so were the patients’ family. After that, I called up the Emergency Physician to thank her and then, I broke down.

I broke down because had he gone on the 23rd itself, he wouldn’t have to gone through this.. He lives alone and his so-called family members aren’t even his biological family members but neighbours and friends… I broke down because I also felt defeated… We tried our best with such limited resources and manpower…

Yet, I couldn’t save him…

If you have YET to come up with a New Year’s Resolution… At least consider this, adhere to your regular check-ups if you have any… Stay compliant to your medications, diet restrictions or any fluid restrictions if you do have…

And if something is off or not right, please RUSH to the nearest clinic or better, the hospital… Because there is only so much that we can do with such limited resources in a community clinic.

Otherwise, I wish that you have a Blessed 2026 filled with love, beautiful memories and wonderful opportunities.

Remember to have fun and do enjoy it but please do so, responsibly.

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Plans lodged for new Morriston Hospital access road and major campus expansion

The proposals include a full application for a 1.57km access road from junction 46 of the M4 and outline plans for a major expansion of Morriston Hospital’s clinical and research facilities.

The health board says the scheme is designed to meet rising demand for acute and specialist care, tackle waiting lists, and modernise facilities. It follows the 2021 City Deal‑backed vision for a life sciences and innovation campus at Morriston.

New access road from Felindre

The proposed single‑carriageway road would run north of Pant‑lasau Road to a new roundabout at the hospital’s northern edge. It includes a shared active‑travel path, sustainable drainage features, and new planting to reduce visual impact.

The health board says the route will ease congestion on existing approaches, improve blue‑light access to the Emergency Department, and support future public transport links from Felindre.

illustrative masterplan of the Morriston Hospital development and new link road

Campus‑style hospital expansion

The outline masterplan sets out a phased redevelopment to create an integrated “Morriston Health Campus” with new clinical, research and support buildings arranged around landscaped public spaces.

Key elements include:

  • Critical Care Centre with new Emergency Department and theatres (18,000m²)
  • Regional South Wales Thoracic Surgery Centre (5,000m²)
  • New ward block providing six wards (9,000m²)
  • Institute for Life Sciences (6,000m²) in partnership with Swansea University
  • Three regional support service buildings, expanded energy and waste centres
  • A central biophilic park and public arrival plaza

The design aims to connect the hospital more closely with its landscape, retain existing trees and hedgerows, and improve pedestrian and cycle links across the site.

Sustainability and access

The plans include renewable energy measures such as roof‑mounted solar panels and heat pumps, plus sustainable drainage systems designed for future climate conditions.

A relocated helipad on the roof of the Critical Care Centre is proposed to speed transfers from air ambulance to the Emergency Department.

Next steps

The application will be considered by Swansea Council. If approved, the access road would be built first, with hospital expansion phases following.

The health board says the development will “significantly enhance the hospital’s functionality, aesthetic appeal, and sustainability, making it a valuable asset to the community.”

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It’s Saturday afternoon. Your child takes a tumble off their bike, and their arm looks… well, not quite right. Or maybe you wake up with a throbbing sore throat and a fever that just won’t quit. #emergencydepartment #expresscare #Medicalemergencies #urgentcare #wheretogetmedicalcare

https://priya.health/emergency-department/

ER, Urgent, or Express: Where to Go?

Confused about ER, urgent care, or express care? A family doctor explains where to get the right medical help when you need it fast.

Health With Priya

Part 1 – Life As A Peri Medical House Officer In Hospital Umum Sarawak | The Emergency Department

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Upon entering the Medical Posting, I was stationed into the “Peri-Medical Pool”. My “birthplace”, so-called.

Prior to entering the Medical Posting, many of my colleagues commented that the Peri-Medical pool is probably one of the worst place to enter considering that it is rather hectic, busy and messy, not to mention the joblist is never ending.

The working shift for a Medical House Officer is as such:

  • Short Day (SD): 7am till 6pm
  • Long Day (LD): 7am till 10pm
  • Night Shift (ON): 8pm till 9am

The Emergency Department in Hospital Umum Sarawak is rather huge and consists of:

  • Green Zone
  • EDAU
  • CSSD
  • Yellow Zone
  • Yellow Respi Zone
  • Green Yellow Zone
  • Red Zone I
  • Res Zone II
  • Decon

Usually a House Officer is allocated to take care of more than one zones.

For example:

  • Green Zone / EDAY / CSSD
  • Yellow Zone / Green Yellow Zone
  • Red Zone I / Red Zone II / Yellow Respi Zone

When the amount of manpower is high, the job gets done quickly and keeping track of the patients is easier.

However, in days where we are stretched thin it is rather difficult.

The Day Shift

Photo by Laura James on Pexels.com

Since I entered the Peri Medical Pool on my Day 1 of tagging in the Medical Posting, my working hours were from 7am till 10pm every day till I offtagged.

I begin my day by first tracing the casenotes of the patients in the zone I am allocated to, snap pictures of the chest x-rays, any relevant radiological reports as well as to trace their bloods.

If bloods were not taken or not in the system, we would then proceed to “summon” the post-night team for help with their bloods.

After all the patients have been traced and the Google Lists have been updated (this is to aid us during our rounds as well as following up on their location later, to ensure that they are not being missed), then I would proceed with my morning reviews.

The morning reviews are just as usual as any morning ward reviews, rounds with the Medical Officer and Specialists and finally carrying out any active joblists.

Since we are in the emergency department, there is usually no afternoon reviews. It depends on the medical officer. Most of the time, rounds are just once daily.

After we are done with our morning joblists, we have to actively screen through the patients in our allocated zones as there is constant movement of the patients in both in and out of the emergency department.

Thus, this means assisting the current on-call team for the day with any STAT bloods or STAT radiological requests as well as updating their progress.

On most days, it is manageable despite the chaos. However, on days where we are lacking in manpower, the difficulty sets in.

The Night Shift

Photo by Photo By: Kaboompics.com on Pexels.com

The night shift begins at 8pm till 9am the following day or until we are done with our “summons”.

I was blessed enough to have gone through perimedical with a partner. Thus, there were two House Officers allocated for the night shift.

As night House Officers in Peri-Medical. We are expected to continue screening through all the casenotes for any new joblist or patients in all the zones in the Emergency Department as well as to assist in any procedures, take STAT bloods or request STAT radiological procedures.

In addition to that, we also have to cover the main building and the side building. This means, if there are any medical patients lodging in non-medical wards, we are in charge of them as well. Most of the time, it is just new transfer ins, sometimes, it is attending to any acute issues.

This is then followed by taking the coming mornings or bloods of the stranded patients in the Emergency Department of the lodging patients.

The amount of patients in the Medical Department is extremely high and thus, the medical patients can be stranded up to days in the Emergency Department which can even last till they are being discharged.

Thus, this ensures that the patients are being continued on their treatment irregardless of their location within the hospital.

The night shift as a perimedical house officer can get rather hectic if there are back-to-back influx of new patients in the Emergency Department, tons of coming mornings as well as acute issues in the ward.

In the morning, the “summoned” list can get rather extensive and chaotic as well and can be rather endless.

Hence, on top of the constant walking about the whole hospital, it can get rather tiring. But like I said, it is doable and manageable.

In fact, I enjoyed life as a perimedical house officer a lot.

If you are due to join Peri-Medical, fret not. Keep yourselves equipped with necessary forms and just work quick and as fast as you can.

On some days, one might get lost in the sea of chaos. However, stay strong and know that help is always within reach and that you are not alone.

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My Evening Routine In The Medical Posting | Housemanship Diaries

An article regarding my Evening Routine while I was serving as a House Officer in my Fifth Posting, the Department of Medical.

The Theoretical Doctor
NHS Greater Glasgow & Clyde Emergency Department Review: March 2025 – Healthcare Improvement Scotland

My First Day In Medical Posting – Tagging Day 1 | Housemanship Diaries

Tell us about your first day at something — school, work, as a parent, etc.

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Finally, my much awaited posting… Medical!

Ever since I was a first poster, I have always looked forward towards the Medical Posting but one I decided to keep as my last as I wanted tolearn and understand the posting rather than just “float” through.

This served as a disadvantage in other postings as when it came to simple management of hyperkalemia or hypokalemia, I wouldn’t know, neither hypoglycaemia or hyperglycaemia.

Instead, I simply memorised my way in terms of the simple management and “referred to Medical” rather than actually learning to correct them myself in other postings.

Thus, I went complex and complicated first prior to building my way up.

My first day in this much awaited posting was on the 11th of December 2024. I had just completed the Surgical Posting and was on a 5-days-break.

On my first day, I was allocated into the “Perimedical Pool”. Deemed as probably the “worst place” to be allocated in. Thus, as usual, the fear starts creeping in.

I started asking around in regards to my job scope as well as the superiors.

Most of them advised to just arrive on time, which I did, at 7am sharp.

That morning, I was allocated to handle the “Yellow Respi” zone of the Emergency Department.

Thankfully, I had a good friend who was my partner for the day.

We began with tracing x-rays of the patients as well as their blood investigations.

After we have gone through all of the patients, we began with our morning reviews while awaiting our medical officer and specialist.

The medical officer arrived and started reviewing the patients with my friend. Here I was, on Day 1, extremely blur.

I introduced myself to the medical officer and he proceeded to tell me to go about my own reviews while he assessed the other patients with my friend.

Alright, here we go again, just like in every posting. Just how and what am I going to review?

Soon, the specialist came and I proceeded to follow the rounds as I was used to in the Surgical Posting where we all followed the grand rounds.

Instead, I was again asked to proceed with reviewing the other patients in the other cubicle while they go about their rounds.

Feeling quite lost and left out, I proceeded as such. Before I knew it, I reviewed all the patients in that particular cubicle just in time when the medical officer and the specialist came.

Thus, I started presenting and writing, still being tuned to the work culture in the Surgical Posting.

Just like rounds in the other postings, we presented, followed, write and after rounds, proceeded with discharges and carrying out the active joblists.

Surprisingly, I had time for lunch.

Afternoon rounds started at 2pm with just the medical officer and my superior was more than kind enough to start explaining and teaching me as to why certain things are as such.

After the PM rounds, I proceeded to screen through the casenotes and update the list of patients in my zone as well as to take any STAT bloods. Before 6pm, I went for my early dinner.

Considering I was tagging, I had to stay till 10pm whereas the rest who are “Short Day” or “SD” went home by 6pm. Thus, from 6pm till 10pm, I was actively screening through the casenotes in the Yellow Zone, Yellow Respi Zone, Red Zone, Red Zone 2, CSSD, EDOU, Green Yellow Zone and updating the list as well as to take any needed STAT bloods which mainly included blood cultures.

A little before 10pm, I approached one of the medical officers to get my signature for the day and went home.

That concludes my first day of tagging in the Medical Posting which surprisingly turned out rather well. For the first day at least.

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My Morning Routine Being A House Officer Leader In The Surgical Posting | Housemanship Diaries

An article regarding my morning routine while being one of the surgical leaders in my fourth posting of my housemanship journey.

The Theoretical Doctor